Breast revision for more upper pole fullness - can I avoid a lift? (Photos)

Question

I have had breast implants since 2012. 250cc in right, 230 cc in keft, saline, over the muscle I am wanting to fet a revision and switch to silicone. My goal is to hace more upper fullness When I had my original surgery i really wanted a more natural look, i am not as concerned about that now I have had 3 consultations, going in inquiring about a lift and revision Dr 1 agred with having both procedures and was insistent (pushy) that hecwould go under the muscle (thats how ge does it snd ges done hundreds of surgeries- his words). The other two doctors both said i don’t need a lift and both said I could stay over the muscle. I am wondering if I can achieve my desired outcome by not doing a lift and going over the muscle. I would like to avoid a lift if possible I am physically active and lift weights so I would also like to avoid under the muscle.

Frank Agullo, MD · Answer

Two of the three surgeons who examined you said no lift is needed. I trust their opinion over an educated guess from photos. What the pictures show: flat upper poles. Saline above the muscle stretches out over fourteen years. Your nipples sit low and the breast tissue hangs below them. The question of whether a lift or no lift really boils down to where your nipple lies against your fold. Yours sits right on the line.

If the nipple sits too low, a larger implant is not going to correct that. The implant just sits there, the tissue slides off the front of it, and you end up with more volume on a breast that still points down. That creates the "waterfall" effect everyone is trying to avoid.

I think you would probably look great with a small circumareolar lift.

Upper fullness comes from gel, an implant with more projection and gel cohesiveness, not from whether it is under or over the muscle. You are active and want to stay out of the muscle since the flexing distorts the breast, which is reasonable. It is possible to get great fullness above the muscle, you just accept a little more visible implant edge and a little less coverage.

#StayBeautiful,

@RealDrWorldWide

John LoMonaco, MD, FACS · Answer

Thanks for the photos.  You have a bit of a long breast fold, a nipple/areola that sits a bit lower on side than the other (like all women) and some lost fullness up top.

An implant exchange using the dual-plane technique (not just dual plane placement) that may roll the nipple up a bit is an option, and there is some uncertainty as to how your tissues will respond. Thats the "silver standard" option.

The "gold standard" is a short scar lift (tennis racket or lollipop shaped scar) with a small implant matched to your breast measurments to shorten the breast and get you more fullness up top.  Under or over the muscle depends on what we see on examination, and there are pros and cons to each.

The subtely textured Motiva implants may also be useful to minimize the implant "bottoming out" but these are less important details that vary from surgeon to surgeon.  25 years idoing just breast and body work have taught me that !  Cheers from Texas.

Here's a case of a patient I treated who was a borderline case like you:

Yasemin Aydinli, MD · Answer

Thank you for laying out your history and goals so clearly. You have had your saline implants over the muscle since 2012, you would like to switch to silicone for more upper pole fullness, and you would prefer to avoid both a lift and a submuscular position. I want to answer you directly and honestly, because the choices you make here will determine how natural and how durable your result is, and in my professional opinion the plan that will truly meet your goals is a little different from what you came in hoping for.
First, on the lift. To achieve the most ideal result &mdash; and, just as importantly, to correct your asymmetry &mdash; I do recommend a lift (mastopexy) together with the implant exchange. An implant can add volume and upper fullness, but it cannot reshape the breast or lift a nipple that has descended, and it cannot fully even out a side-to-side difference. If we simply exchange the implants without a lift, the breast will carry more volume but keep its current shape and asymmetry, and that is the kind of result that tends to look unbalanced rather than refined. A lift is what repositions the nipple, tightens the envelope, and gives you a symmetric, natural shape that lasts.
Second, on the pocket. I would advise placing the implant under the muscle rather than over it. Submuscular placement gives a more natural upper pole with far less visible implant edge or rippling, and &mdash; this matters a great deal for longevity &mdash; it carries the weight of the implant off your own skin so the tissue is not constantly being dragged down. The trade-off to be aware of is the waterfall (Snoopy) deformity, where the implant stays in position but the breast tissue gradually slides over it; this is a genuine risk in any breast that is prone to sagging. However, that same sagging is actually more likely when the implant sits over the muscle, because there your skin and tissue bear the entire load. Two things reduce these risks: choosing a smaller implant, which is lighter and pulls down less, and choosing the implant type carefully &mdash; a textured implant or a very lightweight option such as a B-Lite implant can lower both the risk of settling and the risk of capsular contracture.
I also want to address your training honestly, because it is a real consideration. In someone who works the chest muscles very intensively, like a bodybuilder, a submuscular implant can be displaced into a less favorable position when the muscle contracts. That is something we would weigh carefully together when deciding on the pocket. But it does not change my overall recommendation, because a result without a lift will not give you the shape and symmetry you are looking for, regardless of where the implant sits. The right next step is an in-person examination with measurements and photographs, so I can assess your nipple position, your asymmetry, your skin and tissue quality, and how active your chest muscles are &mdash; and then tailor the lift, the implant type and weight, and the pocket to give you a natural, balanced, and lasting result.

Breast revision for more upper pole fullness - can I avoid a lift? (Photos)

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